Florida Senate - 2020                                     SB 916
       By Senator Baxley
       12-00748A-20                                           2020916__
    1                        A bill to be entitled                      
    2         An act relating to the Program of All-Inclusive Care
    3         for the Elderly; creating s. 430.84, F.S.; defining
    4         terms; authorizing the Agency for Health Care
    5         Administration, in consultation with the Department of
    6         Elderly Affairs, to approve certain applicants to
    7         provide benefits pursuant to the Program of All
    8         Inclusive Care for the Elderly (PACE); specifying
    9         requirements and procedures for the submission,
   10         publication, review, and initial approval of
   11         applications; requiring prospective PACE organizations
   12         that are granted initial approval to apply within a
   13         certain timeframe for federal approval; providing
   14         accountability requirements; exempting PACE
   15         organizations from certain requirements; providing an
   16         effective date.
   18  Be It Enacted by the Legislature of the State of Florida:
   20         Section 1. Section 430.84, Florida Statutes, is created to
   21  read:
   22         430.84Program of All-Inclusive Care for the Elderly.—
   23         (1)DEFINITIONS.—As used in this section, the term:
   24         (a)“Agency” means the Agency for Health Care
   25  Administration.
   26         (b)“Applicant” means an entity that has filed an
   27  application with the agency for consideration as a Program of
   28  All-Inclusive Care for the Elderly (PACE) organization.
   29         (c)“CMS” means the Centers for Medicare and Medicaid
   30  Services within the United States Department of Health and Human
   31  Services.
   32         (d)“Department” means the Department of Elderly Affairs.
   33         (e)“PACE organization” means an entity under contract with
   34  the agency to deliver PACE services.
   35         (f)“Participant” means an individual receiving services
   36  from a PACE organization and who has been determined by the
   37  department to need the level of care required under the state
   38  Medicaid plan for coverage of nursing facility services.
   39         (2)PROGRAM CREATION.—The agency, in consultation with the
   40  department, may approve entities that have submitted
   41  applications required by the CMS to the agency for review and
   42  consideration which contain the data and information required in
   43  subsection (3) to provide benefits pursuant to the PACE program
   44  as established in 42 U.S.C. s. 1395eee and in accordance with
   45  the requirements set forth in this section.
   46         (3)PACE ORGANIZATION SELECTION.—The agency, in
   47  consultation with the department, shall on a continuous basis
   48  review and consider applications required by the CMS for PACE
   49  which have been submitted to the agency by entities seeking
   50  initial state approval to become PACE organizations. Notice of
   51  such applications must be published in the Florida
   52  Administrative Register.
   53         (a)A prospective PACE organization shall submit
   54  application documents to the agency before requesting program
   55  funding. Application documents submitted to and reviewed by the
   56  agency, in consultation with the department, must include all of
   57  the following:
   58         1.Evidence that the applicant is able to meet all of the
   59  applicable federal regulations and requirements established by
   60  the CMS for participation as a PACE organization by the proposed
   61  implementation date.
   62         2.Market studies, including an estimate of the number of
   63  potential participants and the geographic service area in which
   64  the applicant proposes to serve.
   65         3.A business plan of operation, including pro forma
   66  financial statements and projections, based on the proposed
   67  implementation date.
   68         (b)Each applicant must propose to serve a unique and
   69  defined geographic service area without duplication of services
   70  or target populations. No more than one PACE organization may be
   71  authorized to provide services within any unique and defined
   72  geographic service area.
   73         (c)An existing PACE organization seeking authority to
   74  serve an additional geographic service area not previously
   75  authorized by the agency or the Legislature must meet the
   76  requirements set forth in paragraphs (a) and (b).
   77         (d)Any prospective PACE organization that is granted
   78  initial state approval by the agency, in consultation with the
   79  department, shall submit its complete federal PACE application,
   80  in accordance with the application process and guidelines
   81  established by the CMS, to the agency and the CMS within 12
   82  months after the date of initial state approval, or such
   83  approval is void.
   84         (4)ACCOUNTABILITY.—All PACE organizations must meet
   85  specific quality and performance standards established by the
   86  CMS for the PACE program. The agency shall oversee and monitor
   87  the PACE program and organizations based upon data and reports
   88  periodically submitted by PACE organizations to the agency and
   89  the CMS. A PACE organization is exempt from the requirements of
   90  chapter 641.
   91         Section 2. This act shall take effect July 1, 2020.